BILL NUMBER: AB 261	CHAPTERED  09/15/99

	CHAPTER   375
	FILED WITH SECRETARY OF STATE   SEPTEMBER 15, 1999
	APPROVED BY GOVERNOR   SEPTEMBER 15, 1999
	PASSED THE ASSEMBLY   AUGUST 26, 1999
	PASSED THE SENATE   AUGUST 23, 1999
	AMENDED IN SENATE   JULY 7, 1999

INTRODUCED BY   Assembly Member Lempert

                        FEBRUARY 3, 1999

   An act to amend Section 4052 of the Business and Professions Code,
relating to pharmacists.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 261, Lempert.  Pharmacists.
   Existing law authorizes a pharmacist to perform certain procedures
or functions as part of the care provided by a health care facility,
a licensed home health agency, a licensed clinic, as specified, or a
provider under contract with a health care service plan, in
accordance with policies, procedures, or protocols of that facility,
home health agency, licensed clinic, or health care service plan.
Those policies, procedures, or protocols must meet specified
standards.
   This bill would additionally authorize a pharmacist to perform
those procedures or functions in accordance with the policies,
procedures, or protocols of a physician.  The bill would also revise
the standards for those policies, procedures, and protocols to
require that, at a minimum, they require that the medical records of
the patient be available to both the patient's prescriber and the
pharmacist and that the procedures to be performed by the pharmacist
relate to a condition for which the patient has first been seen by a
physician.  The bill would also make a conforming change.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  Section 4052 of the Business and Professions Code is
amended to read:
   4052.  (a) Notwithstanding any other provision of law, a
pharmacist may:
   (1) Furnish a reasonable quantity of compounded medication to a
prescriber for office use by the prescriber.
   (2) Transmit a valid prescription to another pharmacist.
   (3) Administer, orally or topically, drugs and biologicals
pursuant to a prescriber's order.
   (4) Perform the following procedures or functions in a licensed
health care facility in accordance with policies, procedures, or
protocols developed by health professionals, including physicians,
pharmacists, and registered nurses, with the concurrence of the
facility administrator:
   (A) Ordering or performing routine drug therapy-related patient
assessment procedures including temperature, pulse, and respiration.

   (B) Ordering drug therapy-related laboratory tests.
   (C) Administering drugs and biologicals by injection pursuant to a
prescriber's order (the administration of immunizations under the
supervision of a prescriber may also be performed outside of a
licensed health care facility).
   (D) Initiating or adjusting the drug regimen of a patient pursuant
to an order or authorization made by the patient's prescriber and in
accordance with the policies, procedures, or protocols of the
licensed health care facility.
   (5) (A) Perform the following procedures or functions as part of
the care provided by a health care facility, a licensed home health
agency, a licensed clinic in which there is a physician oversight, a
provider who contracts with a licensed health care service plan with
regard to the care or services provided to the enrollees of that
health care service plan, or a physician, in accordance, as
applicable, with policies, procedures, or protocols of that facility,
the home health agency, the licensed clinic, the health care service
plan, or that physician, in accordance with subparagraph (C):
   (i) Ordering or performing routine drug therapy-related patient
assessment procedures including temperature, pulse, and respiration.

   (ii) Ordering drug therapy related laboratory tests.
   (iii) Administering drugs and biologicals by injection pursuant to
a prescriber's order (the administration of immunizations under the
supervision of a prescriber may also be performed outside of a
licensed health care facility).
   (iv) Adjusting the drug regimen of a patient pursuant to a
specific written order or authorization made by the patient's
prescriber for the individual patient, and in accordance with the
policies, procedures, or protocols of the health care facility, home
health agency, licensed clinic, health care service plan, or
physician.  Adjusting the drug regimen does not include substituting
or selecting a different drug, except as authorized by Section 4073.

   (B) A patient's prescriber may prohibit, by written instruction,
any adjustment or change in the patient's drug regimen by the
pharmacist.
   (C) The policies, procedures, or protocols referred to in this
paragraph shall be developed by health care professionals, including
physicians, pharmacists, and registered nurses, and, at a minimum,
meet all of the following requirements:
   (i) Require that the pharmacist function as part of a
multidisciplinary group that includes physicians and direct care
registered nurses.  The multidisciplinary group shall determine the
appropriate participation of the pharmacist and the direct care
registered nurse.
   (ii) Require that the medical records of the patient be available
to both the patient's prescriber and the pharmacist.
   (iii) Require that the procedures to be performed by the
pharmacist relate to a condition for which the patient has first been
seen by a physician.
   (iv) Except for procedures or functions provided by a health care
facility, a licensed clinic in which there is physician oversight, or
a provider who contracts with a licensed health care plan with
regard to the care or services provided to the enrollees of that
health care service plan, require the procedures to be performed in
accordance with a written, patient-specific protocol approved by the
treating or supervising physician.  Any change, adjustment, or
modification of an approved preexisting treatment or drug therapy
shall be provided in writing to the treating or supervising physician
within 24 hours.
   (6) Manufacture, measure, fit to the patient, or sell and repair
dangerous devices or furnish instructions to the patient or the
patient's representative concerning the use of those devices.
   (7) Provide consultation to patients and professional information,
including clinical or pharmacological information, advice, or
consultation to other health care professionals.
   (b) Prior to performing any procedure authorized by paragraph (4)
of subdivision (a), a pharmacist shall have received appropriate
training as prescribed in the policies and procedures of the licensed
health care facility.  Prior to performing any procedure authorized
by paragraph (5) of subdivision (a), a pharmacist shall have either
(1) successfully completed clinical residency training or (2)
demonstrated clinical experience in direct patient care delivery.
   (c) Nothing in this section shall affect the requirements of
existing law relating to maintaining the confidentiality of medical
records.
   (d) Nothing in this section shall affect the requirements of
existing law relating to the licensing of a health care facility.
